Dans cette étude, observationnelle et rétrospective, un traitement combiné d’emblée par une bithérapie orale avant endartériectomie améliore significativement l’hémodynamique préopératoire des patients présentant une HTP TEC opérable sévère.
Cette amélioration des paramètres hémodynamiques avant endartériectomie semble améliorer le devenir post opératoire chez ces patients qui présentent, initialement, une mortalité élevée. L’impact réel de cette stratégie plus agressive est difficile à évaluer en l’absence de groupe contrôle. Néanmoins, l’absence de mortalité mise en évidence dans nos résultats, ainsi que l’amélioration des paramètres fonctionnels et hémodynamiques, et ce malgré un délai plus important à la prise en charge chirurgicale, tendent à suggérer un bénéfice à l’abaissement des RVP en pré opératoire, chez des patients sélectionnés.
Devant ce signal positif, Il semble maintenant important de confirmer ces résultats de façon prospective, en comparant une prise en charge opératoire d’emblée par endartériectomie avec une stratégie comprenant un traitement séquentiel par bithérapie orale puis chirurgie, avec pour critère de jugement principal la morbimortalité.
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